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Measurement of Hallux Valgus Angle

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  #1  
Old 15th April 2013, 12:04 PM
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Default Measurement of Hallux Valgus Angle

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Comparison of Angle Measurements on Hallux Valgus with Two Different Methods Using Digital Images.
Sung IH, Kim KC, Sung CH, Seo WY, Lee DY, Cho YA.
J Korean Foot Ankle Soc. 2013 Mar;17(1):40-44.
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PURPOSE: To study inter- and intra-observer reliabilities of computerized measurements of the angular parameters of hallux valgus deformity, using two different kinds of software tools for angle measurement on the digital radiography.

MATERIALS AND METHODS: On 35 digital radiographies of standing foot anteroposterior view of hallux valgus, two observers (A, B) independently measured hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA1-2) twice, using two methods. In method I, an angle was determined from duplicated lines to longitudinal axes made for bisecting line on the target bones with software tool. In method II, an angle was calculated automatically and directly from bisecting lines (longitudinal axes) made on the target bones. We compared two methods using paired t-test to determine significance of differences. Inter- and intra-observer reliabilities were evaluated using the intraclass correlation coefficients (ICC).

RESULTS: There were no significant differences between measurements of method I and II for each observer (p>0.05) and intraobserver reliability were good. (ICC>0.9) Inter-observer reliability for method I and II was good of the HVA (ICCs, 0.912 and 0.905) and moderate of the IMA1-2 (ICCs, 0.505 and 0.537). There were interobserver differences in HVA of method I and II.

CONCLUSION: No significant difference was found statistically between measurements of method I and II. Both methods I and II would be acceptable to measure angular parameters of hallux valgus deformity.
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Old 13th May 2013, 06:50 PM
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Default Re: Measurement of Hallux Valgus Angle from Digital Images

Approach for measuring the angle of hallux valgus
Jin Zhou, Petr Hlavacek, Bo Xu, Wuyong Chen
Indian Journal of Orthopedics 2013 | Volume : 47 | Issue : 3 | Page : 278-282
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Background: There is medium correlation between the current anthropometric method and the radiography in the angle of hallux valgus (AoH) measurement, so this study aimed at designing a reliable and more accurate approach to measure the AoH (AoH).
Materials and Methods: Fifteen age, body weight, and height matched male students were included and those with foot disorders, deformities, or injuries were excluded from the study. The dorsal protrusions of the first metatarsal and the hallux were marked by palpating from three experienced observers; then their barefoot model in standing was collected by a three dimensional laser scanning system. The AoH was defined in the X-Y plane by the angle between the line joining the marks of centre of head and centre of base of metatarsal shaft and the one connecting the marks of the centre of metatarsal head and the hallux. The same procedure was repeated a week later. Besides, other measures based on the footprint, outline, and the radiography were also available for comparisons. Paired t-test, linear regression, and reliability analysis were applied for statistical analysis with significant level of 0.05 and 95% confidence interval.
Results: There were no significant differences recorded between the new method and the radiographic method ( P = 0.069). The AoH was superior to the methods of footprint and outline and it displayed a relative higher correlation with the radiographic method (r = 0.94, r2 = 0.89). Moreover both the inter and intraobserver reliabilities of this method were proved to be good.
Conclusion: This new method can be used for hallux valgus inspection and evaluation.
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Old 22nd June 2013, 09:11 PM
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Default Re: Measurement of Hallux Valgus Angle from Digital Images

Descriptive Quantitative Analysis of Hallux Abductovalgus Transverse Plane Radiographic Parameters.
Meyr AJ, Myers A, Pontious J.
J Foot Ankle Surg. 2013 Jun 17.
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Although the transverse plane radiographic parameters of the first intermetatarsal angle (IMA), hallux abductus angle (HAA), and the metatarsal-sesamoid position (MSP) form the basis of preoperative procedure selection and postoperative surgical evaluation of the hallux abductovalgus deformity, the so-called normal values of these measurements have not been well established. The objectives of the present study were to (1) evaluate the descriptive statistics of the first IMA, HAA, and MSP from a large patient population and (2) to determine an objective basis for defining "normal" versus "abnormal" measurements. Anteroposterior foot radiographs from 373 consecutive patients without a history of previous foot and ankle surgery and/or trauma were evaluated for the measurements of the first IMA, HAA, and MSP. The results revealed a mean measurement of 9.93°, 17.59°, and position 3.63 for the first IMA, HAA, and MSP, respectively. An advanced descriptive analysis demonstrated data characteristics of both parametric and nonparametric distributions. Furthermore, clear differentiations in deformity progression were appreciated when the variables were graphically depicted against each other. This could represent a quantitative basis for defining "normal" versus "abnormal" values. From the results of the present study, we have concluded that these radiographic parameters can be more conservatively reported and analyzed using nonparametric descriptive and comparative statistics within medical studies and that the combination of a first IMA, HAA, and MSP at or greater than approximately 10°, 18°, and position 4, respectively, appears to be an objective "tipping point" in terms of deformity progression and might represent an upper limit of acceptable in terms of surgical deformity correction.
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Old 23rd April 2014, 03:26 PM
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Default Re: Measurement of Hallux Valgus Angle from Digital Images

The hallux valgus angle of the margo medialis pedis as an alternative to the measurement of the metatarsophalangeal hallux valgus angle.
Klein C, Kinz W, Zembsch A, Groll-Knapp E, Kundi M.
BMC Musculoskelet Disord. 2014 Apr 21;15(1):133.
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BACKGROUND:
Currently, the metatarsophalangeal angle (hallux valgus angle) is measured based on radiographic images. However, using X-ray examinations for epidemiological or screening purposes would be unethical, especially in children. For this reason it is discussed to measure the hallux valgus angle of the margo medialis pedis (medial border of the foot) documented on foot outline drawings or foot scans. As a first step on the way to prove the validity of those approaches this study assesses the hallux valgus angle measured on the margo medialis pedis based on the same x-ray pictures as the metatarsophalangeal hallux valgus.
METHODS:
Radiographic images of the foot were obtained from patients with symptomatic hallux valgus malformation. Twelve sets of contact copies of the 63 originals were made, and were marked and measured according to three different methods, each one performed by two observers and with two repeated measurements. Thus, data sets from 756 individual assessments were entered into the multifactorial statistical analysis.Comparisons were made between the angle of the margo medialis pedis and the metatarsophalangeal angle, which was determined by two different methods. To determine the inter- and intraobserver reliability of the different methods, each assessment was conducted by two independent experts and repeated after a period of several weeks.
RESULTS:
The correlations between the hallux valgus angles determined by the three different methods were all above r = 0.89 (p < 0.001) and thus highly significant. The values obtained by measuring the margo medialis pedis angle, however, were on average 4.8 degrees smaller than the metatarsophalangeal angles. No significant differences were found between the observers. No systematic deviations for any observer between repeated measurements were detected.
CONCLUSIONS:
Measurements of the radiographic hallux angle of the margo medialis pedis are reliable and show high correlation with the metatarsophalangeal angle. Because the hallux valgus angles based on margo medialis pedis measurements were slightly but statistically significantly smaller, these measurements should be considered conservative estimates of the metatarsophalangeal angle. Significant differences between hallux valgus angles based on radiographic and non-radiographic material are unlikely. However this question has to be treated in a second stage in detail.
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Old 21st July 2014, 04:46 AM
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Default Re: Measurement of Hallux Valgus Angle

A comparison of hallux valgus angles assessed with computerised plantar pressure measurements, clinical examination and radiography in patients with diabetes
Daniël MC Janssen, Antal P Sanders, Nick A Guldemond, Joris Hermus, Gerard HIM Walenkamp and Lodewijk W van Rhijn
Journal of Foot and Ankle Research 2014, 7:33 doi:10.1186/1757-1146-7-33
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Background
Hallux valgus deformity is a common musculoskeletal foot disorder with a prevalence of 3.5% in adolescents to 35.7% in adults aged over 65 years. Radiographic measurements of hallux valgus angles (HVA) are considered to be the most reproducible and accurate assessment of HVA. However, in European countries, many podiatrists do not have direct access to radiographic facilities. Therefore, alternative measurements are desired. Such measurements are computerised plantar pressure measurement and clinical goniometry. The purpose of this study was to establish the agreement of these techniques and radiographic assessments.

Methods
HVA was determined in one hundred and eighty six participants suffering from diabetes. Radiographic measurements of HVA were performed with standardised static weight bearing dorsoplantar foot radiographs.

The clinical goniometry for HVA was measured with a universal goniometer. Computerised plantar pressure measurement for HVA was executed with the EMED SF-4(R) pressure platform and Novel-Ortho-Geometry software. The intra-class correlation coefficients (ICC) and levels of agreement were analysed using Bland & Altman plots.

Results
Comparison of radiographic measurements to clinical goniometry for HVA showed an intraclass correlation coefficient (ICC) of 0.81 (95% confidence interval, 0.76 to 0.86; p<0.001). Radiographic measurement versus computerised plantar pressure measurement showed an ICC of 0.59 (95% confidence interval, 0.49 to 0.68; p<0.001). In addition, clinical goniometry versus computerised plantar pressure measurement showed an ICC of 0.77 (95% confidence interval, 0.70 to 0.82; p<0.001). The systematic difference of the computerised plantar pressure measurement compared with radiographic measurement and clinical goniometry was 7.0 degrees (SD 6.8) and 5.2 degrees (SD 5.0), respectively. The systemic difference of radiographic measurements compared with clinical goniometry was 1.8 degrees (SD 5.0).

Conclusions
The agreement of computerised plantar pressure measurement and clinical goniometry for HVA compared to radiographic measurement of HVA is unsatisfactory. Radiographic measurements of HVA and clinical goniometry for HVA yield better agreement compared to radiographic measurements and computerised plantar pressure measurement. The traditional radiographic measurement techniques are strongly recommended for the assessment of HVA.
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Old 21st July 2014, 02:44 PM
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Default Re: Measurement of Hallux Valgus Angle

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A comparison of hallux valgus angles assessed with computerised plantar pressure measurements, clinical examination and radiography in patients with diabetes
Daniël MC Janssen, Antal P Sanders, Nick A Guldemond, Joris Hermus, Gerard HIM Walenkamp and Lodewijk W van Rhijn
Journal of Foot and Ankle Research 2014, 7:33 doi:10.1186/1757-1146-7-33

Quote:
Methods
HVA was determined in one hundred and eighty six participants suffering from diabetes. Radiographic measurements of HVA were performed with standardised static weight bearing dorsoplantar foot radiographs.

The clinical goniometry for HVA was measured with a universal goniometer. Computerised plantar pressure measurement for HVA was executed with the EMED SF-4(R) pressure platform and Novel-Ortho-Geometry software. The intra-class correlation coefficients (ICC) and levels of agreement were analysed using Bland & Altman plots.
It would have been nice if the mentioned if the Plantar pressure measurement was standing or walking. It would also have been interesting, if it was walking to see if there was a directionality to the error of radiographic vs EMED measurement. In walking the windlass will tend to cause more "reverse buckling" and this will tend to incrase HAV angle. I don't know if that has been shown to be true in the liteature. If there was an increase in HAV angle with walking, then this might be evidence for that. So would a standing measurement vs a walking EMED measurement. That would be an easy study for someone to do.

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